Medicare Advantage Plan R5941-014-0 in Clark County, OH
Anthem Medicare Advantage (PPO) • 2026
Medicare Advantage Plan R5941-014-0 in Clark County, OH Anthem Medicare Advantage (PPO) • 2026
Anthem Medicare Advantage (Regional PPO), CMS Plan-ID R5941-014-0, is a 2026 Medicare Advantage Plan (Part C), with prescription drug coverage, by Anthem Blue Cross and Blue Shield. The plan uses a Preferred Provider Organization (PPO) provider network structure.
Based on the most recent CMS data, plan enrollments topped 5,108 members, with 50 in Clark County, Ohio.
Anthem Medicare Advantage Overview
| Plan ID R5941-014-0 Overview | |
|---|---|
| Health Plan ID: | R5941-014-0 |
| Medicare Advantage Plan Type: | Regional PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $87.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $1,000 |
| Annual Out-of-Pocket Maximum: | $6750.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $250.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Clark County, OH |
| Insured By: | Anthem Blue Cross and Blue Shield |
Explore the Benefits of Anthem Medicare Advantage
This MAPD PPO Medicare Advantage plan offers broad coverage with the freedom to choose your providers. With a monthly premium of $87.00, it includes all core benefits under Medicare Part A and Part B, plus prescription drug coverage to manage ongoing medications. The annual Part D deductible is $250.00. You can see any Medicare-approved provider — in or out of network — though in-network care typically costs less.
Primary care visits have a $10 copay | Out-of-network: 50% coinsurance, and specialist visits come with a $40 copay | Out-of-network: 50% coinsurance. Urgent care services carry a $35 copay, and ground ambulance transportation is $330 copay | Out-of-network: $330 copay. These costs all count toward your annual maximum out-of-pocket (MOOP) limit of $6750.00. After that limit is reached, all in-network care is fully covered through the end of the year.
CMS recognizes this plan as R5941-014-0. A detailed breakdown of cost sharing is available below. Still have questions? Check the FAQ section for more insights.
We're Here to Help You Enroll
Cost-Sharing Overview
With Anthem Medicare Advantage, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan R5941-014-0.
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $10 copay | Out-of-network: 50% coinsurance |
| Specialist: | In-network: $40 copay | Out-of-network: 50% coinsurance |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $50-$295 copay | Out-of-network: 50% coinsurance |
| Lab services: | In-network: $0-$10 copay | Out-of-network: 50% coinsurance |
| Outpatient x-rays: | In-network: $90-$110 copay | Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$130 copay | Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $35 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $295 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay | Out-of-network: | 50% per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | 50% per stay |
| Ground ambulance: | In-network: $330 copay | Out-of-network: $330 copay |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Outpatient group therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $295 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay | Out-of-network: | 50% per stay |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Occupational therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-50% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-50% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Dental x-rays: | Not covered |
| Cleaning: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
Vision Services
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | Not covered |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
Hearing Services
Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Anthem Medicare Advantage as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Anthem Medicare Advantage includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $83.90 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $83.90 |
| Low-Income Premium Subsidy: | $31.38 |
| Low-Income Premium Subsidy Paid by CMS: | $31.40 |
| Low-Income Subsidy Premium: | $52.50 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Anthem Blue Cross and Blue Shield starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Anthem Medicare Advantage may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Anthem Medicare Advantage
To enroll in Anthem Medicare Advantage, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in Anthem Medicare Advantage and benefit from its comprehensive coverage options.
Enrollment Periods for Anthem Medicare Advantage
Knowing when you can enroll in Anthem Medicare Advantage is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Enroll in Anthem Medicare Advantage
Getting started with Anthem Medicare Advantage is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Anthem Medicare Advantage. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID R5941-014-0:
How much does R5941-014-0 cost per month?
Members pay their Part B premium and the plan's of $87.00 per month to be in this 2026 plan.
What’s the MOOP for Anthem Medicare Advantage in 2026?
For 2026, the maximum you’d spend out-of-pocket in-network is $6750.00.
How much do I pay before drug coverage starts?
You’ll pay the first $250.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Anthem Medicare Advantage?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
How many people are enrolled in this plan?
As of last month, about 5,108 beneficiaries are enrolled.
Contact Anthem Blue Cross and Blue Shield
| Contact Type | Details |
|---|---|
| Website: | Anthem Blue Cross and Blue Shield Plan Page |
| New Members: | 1-833-668-2393 |
| Existing Members: | 1-800-467-1199 |
| Plan Address: | 1351 William Howard Taft Road | CN14B-818 | Cincinnati, OH 45206 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Anthem Blue Cross and Blue Shield, https://shop.anthem.com/medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
You can compare Plan-ID R5941-014 with the full list of 2026 Medicare Advantage plans, organized by state and county.
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